Rapid Scale-up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic - Nine States, Nigeria, March 31, 2019-September 30, 2020

Abstract

In 2018, an estimated 1.8 million persons living in Nigeria had HIV infection (1.3% of the total population), including 1.1 million (64%) who were receiving antiretroviral therapy (ART) (1). Effective ART reduces morbidity and mortality rates among persons with HIV infection and prevents HIV transmission once viral load is suppressed to undetectable levels (2,3). In April 2019, through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR),* CDC launched an 18-month ART Surge program in nine Nigerian states to rapidly increase the number of persons with HIV infection receiving ART. CDC analyzed programmatic data gathered during March 31, 2019-September 30, 2020, to describe the ART Surge program's progress on case finding, ART initiation, patient retention, and ART Surge program growth. Overall, the weekly number of newly identified persons with HIV infection who initiated ART increased approximately eightfold, from 587 (week ending May 4, 2019) to 5,329 (week ending September 26, 2020). The ART Surge program resulted in 208,202 more HIV-infected persons receiving PEPFAR-supported ART despite the COVID-19 pandemic (97,387 more persons during March 31, 2019-March 31, 2020 and an additional 110,815 persons during April 2020-September 2020). Comprehensive, data-guided, locally adapted interventions and the use of incident command structures can help increase the number of persons with HIV infection who receive ART, reducing HIV-related morbidity and mortality as well as decreasing HIV transmission.

FIGURE 1

Total number of HIV tests conducted, positive test results, and positivity rate (%), by week — nine Nigerian states^, participating in the Antiretroviral Therapy (ART) Surge program, May 4, 2019–September 26, 2020 * Positivity rate was calculated as the number of positive tests divided by the total number of tests conducted using weekly reported programmatic data. Reporting began the week ending with May 4, 2019. Reporting weeks end on Saturdays. ^† Benue, Delta, Enugu, Federal Capital Territory, Gombe, Imo, Lagos, Nasarawa, and Rivers. ^§ On February 27, 2020, the Nigeria Centre for Disease Control confirmed the first confirmed COVID-19 case and activated an Emergency Operations Center on February 28. Thereafter, the government of Nigeria implemented COVID-19 mitigation efforts, including school closures (beginning March 19), international travel bans (beginning March 23), and statewide stay-at-home orders (beginning March 30).

FIGURE 2

Number of newly identified persons with HIV infection who initiated antiretroviral therapy (ART) and proxy indicator for linkage to ART (%), by week — nine Nigerian states^, participating in the ART Surge program, May 4, 2019–September 26, 2020 * Using weekly reported program data, a proxy indicator for ART initiation was calculated as the number of newly identified persons with HIV infection who initiated ART divided by the number of positive test results. ART initiation rates using the proxy indicator could exceed 100%, including if persons with HIV infection identified in one week did not initiate ART until the following week. Weekly programmatic data reporting began the week ending with May 4, 2019. Reporting weeks end on Saturdays. ^† Benue, Delta, Enugu, Federal Capital Territory, Gombe, Imo, Lagos, Nasarawa, and Rivers. ^§ On February 27, 2020, the Nigeria Centre for Disease Control confirmed the first confirmed COVID-19 case, and activated an Emergency Operations Center on February 28. Thereafter, the government of Nigeria implemented COVID-19 mitigation efforts, including school closures (beginning March 19), international travel bans (beginning March 23), and statewide stay-at-home orders (beginning March 30).